What's the treatment for Zollinger-Ellison syndrome?
The primary treatment for ZES is medication to reduce the production of stomach acid. Proton pump inhibitors that suppress acid production and promote healing are the first line of treatment and include lansoprazole, omeprazole, pantoprazole, and rabeprazole. H-2 blockers such as cimetidine, famotidine, and ranitidine may also be used, but may be less effective in
reducing stomach acid. Surgery to treat peptic ulcers or to remove tumors in the pancreas or duodenum are other treatment options. People who have been treated for ZES should be monitored in case the ulcers or tumors recur. For patients with metastatic disease, chemotherapy, interferon, and octreotide may be helpful. The response to these agents in most studies has been low. Liver transplantation for hepatic metastasis also has been reported. For patients with a single confined liver metastatic lesion, surgical resection may be attempted.
Surgical removal of the tumour is the optimal treatment because the tumour can spread to other parts of the body. All patients with sporadic ZES without hepatic metastases or medical contraindications to surgery are advised to undergo surgical resection of the tumor because this decreases the risk of developing liver metastases, which can decrease the survival of these patients.The role and timing of surgical resection in patients with MEN 1 is less clear. An attempt at surgical resection has been recommended if the tumor is larger than 2.5 cm. Cure is rarely achieved by surgical resection in patients with MEN 1; however, it may reduce the risk of subsequent metastatic disease. Because this is a rare tumor, surgical resection should be attempted only at centers with personnel experienced in treating patients with ZES. |
